Provider Demographics
NPI:1720635865
Name:TRAILHEAD PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:TRAILHEAD PSYCHOTHERAPY, LLC
Other - Org Name:MELISSA L EICH-RICHARDSON, LICSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:EICH-RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:413-387-8355
Mailing Address - Street 1:110 N HILLSIDE RD STE 21
Mailing Address - Street 2:
Mailing Address - City:SOUTH DEERFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01373-9727
Mailing Address - Country:US
Mailing Address - Phone:413-387-8355
Mailing Address - Fax:413-200-3100
Practice Address - Street 1:110 N HILLSIDE RD STE 19
Practice Address - Street 2:
Practice Address - City:SOUTH DEERFIELD
Practice Address - State:MA
Practice Address - Zip Code:01373-9727
Practice Address - Country:US
Practice Address - Phone:413-387-8355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty